Chiropractic, Medicine, and Surgery: Putting the Pieces Together by Hans W. Bottesch II, DC

by Hans W Bottesch II, DC on Monday March 14, 2011
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With thousands of research papers and health updates released daily, it is very easy to overlook some very important information regarding low back pain. The beauty of medicine is that our understanding of various conditions and treatment options is changing very rapidly.

In years past, it was recommended that someone with low back pain go on bed rest for weeks until the pain resolves. Now we know how detrimental extended bed rest is on resolving back pain, and it is recommended that those with back pain stay as physically active as possible with only very limited bed rest. The following two statements may have been passed over by many providers and patients alike:

Amir Qaseem and the American College of Physicians (ACP) recently released a new clinical guideline, regarding routine diagnostic imaging use for low back pain stating, "Unnecessary imaging can lead to a series of unnecessary additional tests, interventions, follow ups, and referrals that do not improve patient outcomes."1

In 2007 Circulation, a Journal of the American Heart Association released a statement advising medical physicians to limit the prescription of non-steroidal anti-inflammatory drugs (NSAIDs) like Ibprofen and Motrin, for the treatment of chronic pain for patients at risk for cardiovascular disease.2

Both of these findings hint at a potential opportunity to lower health care costs for the individual patients, and the country as a whole. This begs the question, “Are there other evidence-based, cost-effective treatment options available for those with low back pain?”

With the increasing demands on allopathic physicians to manage treatment time more efficiently, very little time is left to properly evaluate and manage a very common complaint that 31 million Americans suffer from at any given point in time.3 Employing a more comprehensive approach to the evaluation and management of lower back pain, allows for provider collaboration and inter-disciplinary referrals. Patients experience the best approach that suits their needs, eliminate wasteful healthcare spending, as well as unnecessary testing and treatment. They also appreciate the comprehensive nature of collaborative care between disciplines and quicker resolution of their condition.

Chiropractors are non-surgical spine specialists, who are poised to aid the medical profession in the evaluation and management of low back pain conditions. Properly trained and competent, chiropractors are aware of the “red flag” signs and symptoms that necessitate a referral to a specialist for further care.

Symptoms of groin and buttock numbness, spinal instability, fever and chills, unexplained weight loss, abdominal pain, significant morning stiffness, major trauma, and progressive muscle weakness in conjunction with back pain, are all indicative of a more serious pathology that requires urgent medical care and diagnostic imaging. Patients not exhibiting the aforementioned symptoms will not see an improvement in their care if they have diagnostic imaging performed at the onset of care.

Given the high prevalence of these findings and of back pain, the discovery by MRI of bulges or protrusions in people with low back pain may frequently be coincidental.”3 With that said, surgery may be a necessary for those patients who do not improve after exhausting all conservative treatment options, or those who progressively worsen under conservative care.

With regard to medication, despite some of the recent warnings regarding NSAIDs, many back pain patients take them on a regular basis as prescribed by their physicians and often do not experience any side effects. For those interested in conservative management of their low back pain, co-management with your primary care physician for prescription medication is still a viable treatment option to compliment your chiropractor or physical therapist’s treatment plan. Typically, these medications are prescribed as a “rescue medication” for those days when exercise, activity, and self-care treatments do not provide the relief that the patient needs.

In a study by Haas et al., that compared traditional medical treatment to a trial of chiropractic care for chronic low back pain patients, both treatment groups responded well to both types of management. However, the group under chiropractic management reached a lower and sustained pain level ten weeks faster than the group receiving traditional medical care.4

Why is that important to the patient? A lower pain level within two weeks reduces three common habits among those suffering from chronic pain; dependence on NSAIDs and other prescription medication, the development of fear-avoidance behaviors, and the process of catastrophizing symptoms.

The bottom line regarding low back pain is that you are not alone. It is very unlikely that you will experience long-term disability, however such conditions can be successfully managed with conservative care, and while co-management for rescue medication can be appropriate at times, the surgical path should almost always be the last resort.
1. R Chou; A Qaseem; DK Owens; P Shekelle. Diagnostic Imaging for Low Back Pain: Advice for High-Value Health Care From the American College of Physicians. Ann Intern Med. February 1, 2011; 154:181-189.

2. EL Fosbøl; F Folke; S Jacobsen; JN Rasmussen; R Sørensen; TK Schramm; SS Andersen; S Rasmussen; HE Poulsen; L Køber; C Torp-Pedersen; GH Gislason. Cause-Specific Cardiovascular Risk Associated With Nonsteroidal Antiinflammatory Drugs Among Healthy Individuals. Circ Cardiovasc Qual Outcomes. June 8, 2010; DOI: 10.1161/CIRCOUTCOMES.109.861104.

3. M Jensen, Muscle Brant-Zawadzki, N Obuchowski, MModic, D Malkasian, J Ross. Magnetic Resonance Imaging of the Lumbar Spine in People without Back Pain. N Engl J Med 1994; 331:69-73July 14, 1994.

4. M Haas; B Goldberg; M Aickin; B Ganger; M Attwood. Practice-Based Study of Patients With Acute and Chronic Low Back Pain Attending Primary Care and Chiropractic Physicians: Two-Week to 48-Month Follow-Up. J Manipulative Physiol Ther 2004;27:160-9.
Posted in not categorized    Tagged with Chiropractic, Medicine, Surgery, Low Back Pain, Conservative Treatments for Low Back Pain, Conservative Treatments for Back Pain, Red Flags Back Pain


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